Two local doctors try new model to offer 'customized, enhanced primary care'

After more than two decades as traditional family practice physicians with a steady stream of patients at their Mystic and New London offices, Drs. Thomas Blum and Rosemary Bontempi are converting to a new way of delivering medical care.

"Over the years the process of running a traditional practice and taking care of patients has become harder and harder," said Blum, who's been part of Mystic Medical Group with five other doctors since 1987, while Bontempi joined in 1990. "This is for us a tremendous opportunity to practice medicine in a way we haven't been able to for many years."

Starting Sept. 1, Blum and Bontempi will still be seeing patients at the same Sandy Hollow Road office in Mystic, but as part of MDVIP, a Florida-based company that reconfigures existing medical practices into what are called "concierge," "retainer medicine" or "personalized, preventive health care" providers.

Blum prefers another term - "customized, enhanced primary care" - to describe the new model he and Bontempi are adopting, part of a long-term national shift away from private, standalone medical practices.

The two doctors - the other four physicians in Mystic Medical Group will not be part of MDVIP - are the first in New London County to make the change, although "concierge" practices have existed in other parts of the country at least since 2000. Elsewhere in Connecticut, there are seven other MDVIP practices, as well as other concierge practices affiliated with other organizations, though the model isn't common, and the Connecticut State Medical Society doesn't have specific numbers.

Blum said he and Bontempi each have about 1,500 patients, all of whom received letters last month inviting them to enroll in the new program. Each doctor would limit his or her practice to 600 patients, who would each pay $1,800 annually for special access and services. That would include a comprehensive yearly physical lasting 90 minutes to two hours, with advanced screening and diagnostic tests, as well as development of an individual wellness plan covering heart, nutrition, fitness and emotional health. Follow-up and sick visits during the year would typically last 30 minutes each. Blum said with his current caseload, follow-up care and sick visits last an average of 8 to 10 minutes.

Patients who sign up for the service would be given a special phone number to call to reach either the doctor or the doctor's secretary to schedule a same-day or next-day appointment, plus the doctor's cellphone number for after-hours and the assurance that their doctor will see them in the hospital. As before, the doctors would bill insurance for the follow-up and sick care visits, Blum said.

He said he was attracted to MDVIP, which includes more than 700 doctors nationwide, after exploring other alternative practice models such as joining a hospital network or a larger group practice. MDVIP, he said, offered the best option for being able to continue to provide the kind of personal care he believes in.

"We wanted to maintain our autonomy and our own professional identity," Blum said.

In addition to the letter, the two doctors are talking to their patients about joining MDVIP during regular office visits, inviting people to learn about the program on a website by calling a toll-free number, and hosting a forum for prospective enrollees July 1 at the Mystic Marriott. Those who opt not to join will be given a list of doctors in the area who are accepting new patients, along with a "continuity of care plan," Blum said. Thus far, he added, he and Bontempi are about one-third of the way toward their goal of 600 patients each.

Steven Bunin of East Lyme is one of the early enrollees, having paid a deposit on the annual fee and set up a quarterly payment schedule. Blum has been his physician for about 25 years, he said. He sees the new arrangement as a way for Blum to cope with the increasing pressures on general practitioners that are driving many away from the field.

"He's my doctor, and I wouldn't think of changing," he said.

One of the attractive features for Bunin is that joining gives him same-day or next-day access to MDVIP doctors in Florida, where the 72-year-old retired businessman spends the winters.

"That gives me a great deal of peace of mind," he said.

Dan Hecht, chief executive officer of MDVIP, said his company was founded in 2000 to provide primary care doctors a way to "get off the treadmill" of trying to fit in more and more patients each day with diminishing returns in terms of their own job satisfaction and quality of care.

"Patients were waiting three weeks for an appointment, then waiting three hours in the waiting room to see the doctor for three minutes," he said. "That's no way to prioritize health."

About half of the patients who enroll in MDVIP practices are covered by Medicare, he said, and data show that all of the 215,000 patients in these practices nationwide have lower hospitalization and readmission rates than the national average.

"Our practices have older and very ill and sick patients as well as patients who want to stay well," he said. "The common thread is people who say that their health is a priority."

Nationwide, he estimates that about 1 percent of primary care physicians have adopted the concierge model, though interest continues to grow. Hecht disagrees with criticism that these practices are further constricting the limited supply of general practitioners, forcing patients unable or unwilling to pay the annual fee to find care in already overwhelmed offices. Instead, he contends, concierge medicine is keeping general practitioners in the field when they might otherwise quit or retire early.

"There is certainly a challenge in the U.S. with the number of primary care doctors," he said. "But we're helping doctors continue to practice and stay in their profession."

MDVIP provides its practices with legal, marketing and technical support for their offices, including electronic medical records equipment, and online nutrition and wellness tools for patients, among other services.

"We don't own or manage the practices," Hecht said.

Like Hecht, Dr. Robert Wergin, president-elect of the American Academy of Family Physicians, used the "treadmill" analogy to explain why some of his colleagues are attracted to concierge medicine, as well as other new practice models.

"This allows doctors to spend more time with patients and develop relationships, which are the key to outcomes," said Wergin, who runs a private practice in Milford, Neb. "I didn't go to medical school to fill out Blue Cross forms. The traditional fee-for-service model is a treadmill."

Concierge practices, however, probably are not the answer for improving medical quality and access on a national scale, he said. They may work well in "small enclaves" with a sufficient supply of doctors, he said, "but it's probably not the answer for population-based medicine" or for rural areas with few physicians.

There is, however, growing interest among doctors in the concept, noting that it will be one of the topics at an upcoming annual conference of the family physician academy, Wergin added.

Doctors who adopt the concierge model usually enjoy a very modest increase in their annual salaries, said Dr. Domenic Casablanca, a family physician in Shelton who took preliminary steps toward joining MDVIP in 2009. His main motivation, he said, wasn't money, but the chance to be relieved of overwhelming paperwork and patient demands on him as a solo practitioner. After he announced the pending change to patients, several dozen signed up.

"Then it plateaued," he said. "I had too many patients not willing to pay the price."

Instead, he merged with a larger group practice, and is satisfied with that model for now.

"If I had gotten a critical mass of patients, it (MDVIP) would have been a good thing," Casablanca said. "I may have been ahead of my time."